Shakeel S, Rashid R, Jafry NH, Mubarak M. Adult minimal change disease: Clinicopathologic characteristics, treatment response and outcome at a single center in Pakistan. World J Nephrol 2024; 13(4): 99643 [DOI: 10.5527/wjn.v13.i4.99643]
Corresponding Author of This Article
Muhammed Mubarak, FCPS, Professor, Department of Histopathology, Sindh Institute of Urology and Transplantation, Chand Bibi Road, Karachi 74200, Sindh, Pakistan. drmubaraksiut@yahoo.com
Research Domain of This Article
Urology & Nephrology
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Nephrol. Dec 25, 2024; 13(4): 99643 Published online Dec 25, 2024. doi: 10.5527/wjn.v13.i4.99643
Adult minimal change disease: Clinicopathologic characteristics, treatment response and outcome at a single center in Pakistan
Shaheera Shakeel, Rahma Rashid, Nazarul H Jafry, Muhammed Mubarak
Shaheera Shakeel, Rahma Rashid, Muhammed Mubarak, Department of Histopathology, Sindh Institute of Urology and Transplantation, Karachi 74200, Sindh, Pakistan
Nazarul H Jafry, Department of Nephrology, Sindh Institute of Urology and Transplantation, Karachi 74200, Sindh, Pakistan
Author contributions: All four authors contributed significantly and equally to the preparation of the manuscript; Shakeel S and Mubarak M conceived and designed the study; Shakeel S, Rashid R, and Jafry NH performed the research; All four authors participated in primary and final drafting; Mubarak M critically reviewed and finalized the draft; All authors read and approved the final manuscript.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Sindh Institute of Urology and Transplantation.
Informed consent statement: All study participants provided informed written consent regarding personal and medical data collection before study enrolment.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
Data sharing statement: Data are available from the first author and can be shared on reasonable request.
STROBE statement: The authors have read the STROBE Statement—a checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-a checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Muhammed Mubarak, FCPS, Professor, Department of Histopathology, Sindh Institute of Urology and Transplantation, Chand Bibi Road, Karachi 74200, Sindh, Pakistan. drmubaraksiut@yahoo.com
Received: July 26, 2024 Revised: August 26, 2024 Accepted: September 19, 2024 Published online: December 25, 2024 Processing time: 103 Days and 17.1 Hours
Abstract
BACKGROUND
Minimal change disease (MCD) is a significant cause of idiopathic nephrotic syndrome (INS) in adults, representing approximately 10%-15% of INS cases. The data is scanty on clinicopathological features, treatment responses, and long-term outcomes of MCD in adults.
AIM
To determine the clinicopathologic characteristics, treatment responses, and medium-term outcomes of adult patients with MCD in Pakistan.
METHODS
This retrospective cohort study included all adult patients with biopsy-proven MCD treated at the adult nephrology clinic, Sindh institute of urology and transplantation, between January 2010 and December 2020. The data was retrieved from the original renal biopsy request forms in the histopathology archives and the case files. Data on demographics, clinical presentation, laboratory findings, treatment regimens, and outcomes were collected and analyzed. Complete remission (CR), partial remission (PR), relapse, and steroid resistance were defined according to standard criteria. Statistical analyses were performed using statistical product and service solutions, Version 22.
RESULTS
The study cohort included 23 adults [15 (65.2% males), mean age 26.34 ± 10.28 years]. Hypertension was found in 7 (30.4%) and microscopic hematuria in 10 (43.4%) of participants. Laboratory findings revealed a mean serum creatinine of 1.03 ± 1.00 mg/dL, mean serum albumin of 1.94 ± 0.90 g/dL and mean 24-hour urinary proteins of 4.53 ± 2.43 g. The mean follow-up time was 38.09 ± 22.3 months. Treatment with steroids was effective in 16/18 (88.8%) of patients, with 10/16 (62.5%) achieving CR and 6/16 (37.5%) achieving PR. Two patients were resistant to steroids and required second-line immunosuppressive therapy. Relapse occurred in 4/20 (19.04%) of patients, with a mean time to first relapse of 6.5 ± 3.31 months. At the last follow-up, 18/20 (85.7%) of patients were in remission, and 16/20 (76.1%) maintained normal renal function. No patients progressed to end-stage renal disease or died.
CONCLUSION
MCD in adults shows a favorable response to steroid therapy, with a majority achieving remission. However, relapses are common, necessitating second-line immunosuppressive treatments in some cases. The study highlights the need for standardized treatment guidelines for adult MCD to optimize outcomes.
Core Tip: Minimal change disease (MCD) constitutes the third most common cause of nephrotic syndrome in adults. The information is scanty on the clinicopathological features, treatment responses, and long-term outcomes of MCD in adults, particularly from developing countries. This study revealed that MCD in adults shows a favorable response to steroid therapy, with a majority achieving remission. However, relapses are common, necessitating second-line immunosuppressive treatments in some cases. The study highlights the need for standardized treatment guidelines for adult MCD to optimize outcomes.
